Diagnostic ultrasound imaging has no known risks or long-term side effects. Discomfort to the patient is very rare if the sonogram is accurately performed by using appropriate frequencies and intensity ranges. However, the application of the ALARA principle is always recommended.
There are reports of low birth weight of babies after applying more than the recommended ultrasound examinations during pregnancy. Women who think they might be pregnant should raise this issue with the doctor before undergoing an abdominal ultrasound, to avoid any harm to the fetus in the early stages of development.
Since ultrasound is energy, sensitive tissues like the reproductive organs could possibly sustain damage if vibrated to a high degree by too intense ultrasound waves. In diagnostic ultrasonic procedures, such damage would only result from improper use of the equipment.

Possible ultrasound bioeffects:
The thermal effect is controlled by the displayed thermal index and the mechanical index indicates the risk of cavitation.
An ultrasound gel is applied to obtain better contact between the transducer and the skin. This has the consistency of thick mineral oil and is not associated with skin irritation or allergy.
Specific conditions for which ultrasound may be selected as a treatment may be attached with higher risks.

See also Ultrasound Imaging Procedures, Fetal Ultrasound and Obstetric and Gynecologic Ultrasound.

(TI) The definition of the thermal index is the ratio of the total acoustic power to that required raising a maximum temperature increase of 1 °C under defined assumptions. A thermal index of 1 indicates the acoustic power achieving a temperature increase of 1 °C. A thermal index of 2 has the doubled power but would not necessarily indicate a peak temperature rise of 2 °C. The temperature rise is dependent on tissue type and is particularly dependent on the presence of bone.
Classifications of thermal indices:
For fetal ultrasound, the highest temperature increase would be expected occurring at bone. Therefore, TIB gives the worst-case conditions. If the ultrasound system can exceed an index of 1, the mechanical index and thermal index must be displayed. The displayed indices are based on the manufacturer's data.

See also Cranial Bone Thermal Index, Bone Thermal Index, Soft Tissue Thermal Index.

The main advantage of ultrasound is that certain structures can be observed without using radiation. However, ultrasound is energy and there are ultrasound safety regulations, because two bioeffects of ultrasound are heat and cavitation. Ultrasound is a mechanical energy in which a pressure wave travels through tissue. Reflection and scattering back to the transducer are used to form the image. As sound energy is transmitted through the tissue, some energy is reflected and some power is absorbed.
Possible physical effects with ultrasound:
The ultrasound safety is based on two indices, the mechanical index (MI) and the thermal index (TI). The WFUMB guidelines state that ultrasound that produces temperature rises of less than 1.5°C may be used without reservation. They also state that ultrasonic exposure causing temperature rises of greater than 4°C for over 5 min should be considered potentially hazardous. This leaves a wide range of temperature increases which are within the capability of diagnostic ultrasound equipment to produce and for which no time limits are recommended. However, it has not been determined that medical ultrasound causes any adverse reaction or deleterious effect.
The American Institute of Ultrasound in Medicine states that as of 1982, no independently confirmed significant biologic effects had been observed in mammalian tissue below (medical usage) 100mW/cm2.

See also Ultrasound Regulations and Ultrasound Radiation Force.